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Current Trends Cancer Patient Survival by Racial/Ethnic Group -- United States, 1973-1979

To study the survival differences by race and ethnic group of patients with a first primary cancer, the National Cancer Institute analyzed data from its Surveillance, Epidemiology and End Results Program (SEER). The study included cases diagnosed in the period 1973-1979 and followed through December 31, 1981. Eight racial/ethnic groups in the U.S. population--Anglos, Hispanics, blacks, American Indians, Chinese, Japanese, Filipinos, and Hawaiians--were evaluated (1). At the time of the analysis, the SEER program included roughly 10% of the U.S. population (all residents of the states of Connecticut, Hawaii, Iowa, New Mexico, and Utah and the metropolitan areas of Atlanta, Georgia; Detroit, Michigan; San Francisco, California; and Seattle, Washington). Survival is reported as a 5-year relative survival rate, the ratio of the observed survival rate for the patient group to the expected survival rate for persons in the general population similar to the patient group in age, race, sex, and calendar year.

Survival rates for Anglo females exceeded those for Anglo males for each major primary site except urinary bladder (Table 3). The primary site with the highest survival rate among each group studied was the thyroid gland, which had a 5-year relative rate of 91% for all races combined. Rates were uniformly low (under 9%) for each racial/ethnic group and both sexes for cancers of the esophagus, liver, and pancreas. Survival rates for Hispanics were almost identical to those for Anglos, with the largest difference observed for females with bladder cancer. Black males experienced poorer survival than Anglo males for cancer of the rectum, prostate, bladder, and thyroid; black females had poorer survival than Anglo females for cancers of the bladder, corpus uteri, and breast. For many primary sites, Japanese experienced the highest survival rates, and American Indians, the lowest. Although numbers of cases are small, and the survival rates are unstable, survival rates for Chinese and Native Hawaiians are roughly comparable to those for Anglos, whereas survival rates for Filipinos resemble those for blacks. Reported by JL Young, DrPH, LG Ries, ES Pollock, ScD, Operations Research Br, LP Boss, PhD, C Baquet, MD, Cancer Control Applications Br, Div of Cancer Prevention and Control, National Cancer Institute.

Editorial Note

Editorial Note: For a specific cancer site, survival time after diagnosis is related to the extent of disease at diagnosis (stage), the effectiveness of treatment, and biologic and behavioral differences. If the cancer is widespread at diagnosis (higher-stage disease), survival time decreases. However, the extent of disease at diagnosis does not completely account for these differences in survival. For breast cancer in each stage, whites had higher survival rates than blacks.

Japanese patients have consistently higher survival rates than Anglo patients. Since 83% of the Japanese included in this analysis were residents of Hawaii, and survival rates of Anglo patients in Hawaii exceeded those of their Anglo counterparts on the mainland, the high rate for Japanese patients may primarily reflect the general high survival rates among patient groups in Hawaii.

The effect of socioeconomic status (SES) on cancer patient survival may partially explain these racial differences. A study of white cancer patients in Iowa demonstrated poorer survival among those of low SES, like those of blacks elsewhere (2). Likewise, in a study of breast cancer in blacks, using six different indicators of SES, blacks of lower SES experienced poorer survival than blacks of higher SES (3).

These differences in SES may be related to differences in treatment. In a randomized trial in New York to determine the efficacy of breast screening, the unscreened control group showed a lower 5-year survival rate for nonwhite women with breast cancer than for white women with breast cancer. In the screened group, the breast cancer survival rates of the two racial groups did not differ (4). In a Veterans Administration study, except for bladder cancer, patient survival did not differ by race (5). It appears that treatment differentials may play a role in the differences in survival observed among ethnic groups. In the Veterans Administration study, in which patients of all races were treated similarly, most survival differentials did not exist. Studies are currently under way to investigate the role of additional factors in the survival differentials of the racial/ethnic groups.

References

  1. Young JL Jr, Ries LG, Pollack ES. Cancer patient survival among ethnic groups in the United States. J National Cancer Institute 1984;73:341-52.

  2. Berg JW, Ross R, Latourette HB. Economic status and survival status of cancer patients. Cancer 1977;39:467-77.

  3. Dayal HH, Power RN, Chiu C. Race and socio-economic status in survival from breast cancer. J Chronic Dis 1982;35:675-83.

  4. Shapiro S, Venet W, Strax P, Venet L, Roeser R. Prospects for eliminating racial differences in breast cancer survival rates. Am J Public Health 1982;72:1142-5.

  5. Page WF, Kuntz AJ. Racial and socioeconomic factors in cancer survival. A comparison of Veterans Administration results with selected studies. Cancer 1980;1029-40.



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